Castle Place Practice Dr James Squire Primary Care 90% patient - - PowerPoint PPT Presentation

Castle Place Practice Dr James Squire

Primary Care

90% patient contact in NHS is with Primary Care General Practice Changing and Challenged

Pressure of rising demand, aging population, complexity of health Decline in number of GPs, and part-time working patterns of GPs

Current Primary Care Access

Varies per area, difficulty of appointments with own GP or any GP Being addressed locally as it arises in different ways

Continuity of Care Vs Urgent Episodical Cases

Own GP continuity still regarded as most effective for LTC patients Any GP or other healthcare practitioner roles are developing

depending on patients’ presenting issue

Improving access 8-8 by end of 2018 across Devon adds to challenges

One Practice Perspective-part of Tiverton population

• Castle Place Practice – access to GPs
• Currently excellent, but not experienced everywhere in Devon
• Not complacent, can’t stand still and do nothing
• Potentially fragile, given traditional reliance on currently reducing workforce
• Key to Future – Collaborative working across a place
• Work with patients, health, social, community, voluntary, place local services
• Collaborate to set and manage expectations, prioritise need, design solutions together
• Castle Place Practice- approached RD&E
• RD&E are the acute, community and social care* provider in Eastern Devon
• January 2018 Castle Place Practice joined this collaboration-start of the journey
• Castle Place Practice –approached Tiverton Health and Well-being Forum
• Raise awareness, better engage, navigate, signpost and expand to social prescribing
• Tiverton Community Conversation (27.03.2018) –bring together active Tiverton organisations
• What do we do well; what are the gaps/needs; work more collaboratively to ensure we are

an active, smartly resourced and connected community

• Technology
• Pivotal to future service provision
• Pro-active prevention work

Winter 2017/2018

• SPOA (Single Point of Access)/ MTU – Service is good
• SPOA –Resources for community care are improving but naturally a finite resource
• Discharge/blockage
• GP involvement is post discharge – We aim to work differently in future
• Liaison nurses /GP dynamically linked to complex care team
• Currently multi-agency and patient own GP focused
• Aim for integrated and more urgent response by same day service. Prior to this point

– be more proactive and use community connections to identify and support vulnerable patients earlier - link to Tiverton Community Conversation

• This winter?
• Difficult flu year in some areas
• Generally positive
• CASE STUDY
• Shortage of district nurses at points put some pressure on the system

NOTE – Advise to seek official views of LMC, CCG & RDE

CASE STUDY– 90 year old

History of occasional falls

• steoporosis,

hypertension

Lives alone and uses stick,

family in same town

Social housing 2nd floor

flat, no lift

No care package Following a Fall Rapid Response Try to

Keep Home

Admission for medical

needs only

Discharge facilitated by

Rapid Response

Interventions in place to

prevent further falls.

UC- Urgent Care RR – Rapid Response via Single Point of Access (SPOA) PM – Paramedic GP – Doctor CT – CT Scan COTE – Care of the Elderly Consultant Psych – Elderly Pschiatry CPP – Castle Place Assessment Team Matron – Community Matron SS – Social Services facilitated care package

PRE-ADMISSION HOSPITAL POST-DISCHARGE 28/01 UC 05/02 to 23/02 23/02 CPP 30/01 Family CT Head/Pelvis 27/02 Matron 31/01 RR COTE 01/03-03/03 Fam 03/02 PM Psych 07/03 SS 05/02 GP

Benefits of This System

Patient happier in own home Less time in hospital to decondition – better prognosis Less confusion when at home and less risk of infections Specialist time focused on patients with medical need Assessments in home are more realistic Less costly – can help more people Good multidisciplinary working Funding must flow appropriately